With a Washington-based scientist visiting Manchester and the possibility of an appearance by a former surgeon general, the debate on water fluoridation could come to a boil this week as voters weigh their options and a judge hears a lawsuit that could affect a referendum scheduled for Sept. 14.

The government scientist is John William Hirzy, a chemist who works for the Environmental Protection Agency and is an outspoken opponent of fluoridation. The former surgeon general is C. Everett Koop, who has long been a proponent of adding fluoride to drinking water to reduce tooth decay.

Four years ago, Hirzy, a senior scientist in the EPA’s Office of Pollution Prevention and Toxics who was at the time vice president of the EPA workers’ union, called on Congress to study the effects of fluoride and declare a national moratorium on fluoridation.

Hirzy is expected to speak on Tuesday night at an informational meeting on fluoridation that Hooksett officials have scheduled for 7 p.m. in the town library. He is expected to address the town council in Bedford on Wednesday night, according to Rep. Barbara J. Hagan of Manchester.

Hagan, who opposes fluoridation, took issue yesterday with the distribution in Manchester schools of a two-page summary of information touting the benefits of fluoridated water.

“I want equal time,” Hagan said, firing off a letter of protest to Frederick Rusczek, director of Manchester’s Health Department.

“They are grasping at straws. They must be worried,” Hagan said of the proponents.

Koop, a pediatrician by training, was President Ronald Reagan’s surgeon general in the 1980s. In that role, he took on tobacco, condemning smoking and calling for a “smoke-free” society. He also warned of the scourge of AIDS at a time when many in government were silent on the disease.

Koop now writes and speaks out on public health issues through the C. Everett Koop Institute at Dartmouth College.

Rusczek said Friday that he had invited Koop to speak on fluoridation in Manchester this week.

“It’s tentative,” Rusczek said. “We would be delighted if we were able to work it out and have Dr. Koop hold a press conference.”

Anita Bond, executive secretary of the Koop Institute, said yesterday that Koop may attend a news conference in Manchester on Thursday.

“He has said he would try to be there, but at this point I can’t confirm that. I have to speak with him and I won’t be doing that until Tuesday,” Bond said.

With regard to Koop, Hagan conceded that, “If they can get a speaker of that caliber, I guess it would be a point for their side.”

On the other hand, in the tug of war over the safety and efficacy of fluoridation, she said, “It seems to show that our grassroots effort is making headway. I think we have effectively presented that there are two sides to this: That whether or not people agree that this stuff is safe (when applied directly to teeth), they certainly shouldn’t be continuing to ingest it because we’re pouring it into the public water supply.”

History in NH

About 162 million Americans live in the 10,000 communities where fluoride is added to drinking water. Since 1955, when Durham fluoridated its water, nine other New Hampshire communities have done so: Concord, Dover, Hanover, Laconia, Lancaster, Lebanon, Portsmouth, Rochester and, since December 2000, Manchester.

Opponents took issue with the distribution of Manchester water in communities that had not voted in the city’s 1999 fluoridation referendum. That led to a Supreme Court order and legislative action to hold a regional referendum on the question of whether fluoridation should be continued.

The vote is to be held during the primary election on Sept. 14 in Bedford, Goffstown, Hooksett, Londonderry and Manchester.

On Wednesday, however, a hearing is scheduled in Hillsborough County Superior Court on a lawsuit that contends voters in Auburn and Derry should be included in the referendum because some residents in those communities drink the fluoridated water distributed by Manchester Water Works.

“It’s bewildering to me as to why, in Manchester, this is such a huge issue,” said Rusczek, the city’s public health director, noting that in the four years since Manchester began fluoridating, the number of Americans who drink fluoridated tap water has increased from 145 million to 162 million.

HHS goals

“Our state Department of Health and Human Services has a goal of having 65 percent of New Hampshire public water supplies fluoridated by 2010.” That’s good, in Rusczek’s opinion, almost equal to the national figures that show two-thirds of the water systems in the nation are fluoridated.

Rusczek has no qualms about endorsing fluoridation; nor does Dr. James W. Squires, president of the New Hampshire Endowment for Health, or Dr. Alphonse J. “Skip” Homicz, president of the New Hampshire Dental Society.

“It’s regulated and allowed by the folks with oversight at the EPA and the (state and federal) departments of health,” said Rusczek. “If they are not finding issue with it, I don’t have an issue with it.”

Squires, a former state senator, worked with a coalition that issued an oral health plan for New Hampshire a year ago. When it came to effective methods of “public health intervention,” the group’s report urged programs that “maximize the benefits of fluoride in preventing and controlling dental caries.”

Said Squires:

“The decision to implement fluoridation is a local one. It’s eventually a political decision and that will be decided in some sort of voting procedure. . . . But it’s fair to say the coalition supports the idea that fluoridation is a major way to prevent tooth decay, particularly in children.”

Experts on board

Homicz is convinced that, when it comes to fluoridation, all the bona fide experts are “on board.”

“The only negatives come from the ‘antis’ who don’t want anything added to the water. But this stuff is effective and safe. . . .

“In the last 55 years, there has never been any peer reviewed juried articles that show any harm from fluoride, period, “ Homicz said.

Paul Connett disagreed, suggesting there may be an attitude shift when the National Research Council reports early next year on how much fluoride the human body can safety take in.

“It’s usually always the pro-fluoridation people, but this panel is as close to a balanced panel on this issue as we’ve every had in 50 years,” said Connett, a professor of chemistry and toxicology at Lawrence University in Canton, N.Y.

Inside and outside

Connett, who spoke at a forum in Manchester last month, has been on the anti-fluoridation bandwagon since his wife badgered him into reading some of the literature about eight years ago.

He said putting fluoride in drinking water is not like putting vitamin C in fruit juice or adding other nutrients to foods because anyone who is sensitive to a particular nutrient can avoid the foods that contain it.

Nutrients, said Connett, “work internally on the entire system,” but fluoride’s benefit is topical — absorbed directly into the tooth’s enamel.

Connett said he can see the value in government ordering mass immunization to control or prevent a contagious disease, “but not the notion of using some kind of police power to enforce systemic exposure to something which works topically to reduce a minuscule amount of tooth decay.”

Dictums of government

Dr. Leonard L. Weldon has a practice in Keene where he specializes in oral and maxillofacial surgery.

“From the research I’ve seen, topical fluoride is excellent, but to take it systemically is not that great or helpful,” Weldon said.

“Many of us accept the dictums of government. . . . I didn’t question this for a long time, but I have strong reservations now,” Weldon said of his conviction that the intake of too much fluoride may have a toxic effect.

“I tell my patients, ‘You are your own best doctors. Look into yourselves, do some reading.’ . . . I think I have seen good evidence that says fluoride is something we ought to think about as to whether it’s good for us,” Weldon said.

In Lebanon, Dr. Elaine A. Brown puts a holistic slant on dentistry. She does not use mercury-based amalgam for fillings, recommends brushing with an herbal-based toothpaste, sees no benefit in fluoride, even when topically applied.

Brown said she quietly turned away about seven years ago from the fluoride “indoctrination” prevalent in her profession.

“Interesting enough the response from parents has been one of gratitude. It’s amazing how many people are suspicious of fluoride, but are very quiet about it,” Brown said.